Artikel
Outcome of radical prostectomy in patients with prostate cancer and preoperative Gleason score ≥ 8
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Veröffentlicht: | 20. März 2006 |
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Gliederung
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Objectives: Prostate cancer associated with a high Gleason score has often indicated an aggressive biological behavior and a high rate of occult pelvic lymph node metastases. 10- and 15-year cancer specific survival rates are said to be significantly lower in patients with Gleason 8 to 10 PCA. It was the purpose of our retrospective analysis to evaluate the clinical outcome of 105 patients with high grade PCA having undergone radical prostatectomy.
Patients & Methods: A total of 105 patients were identified as having pathological Gleason score 8 or greater in the radical prostatectomy specimen. 47 patients (44.8%) exhibited Gleason score 8, 54 patients (51.4%) and 4 patients (3.8%) demonstrated Gleason score 9 and 10, resp.. Adjuvant endocrine treatment was administered in all patients with additional poor prognostic features such as seminal vesicle invasion (n=47, 44.7%) or lymph node metastases (n=30, 28.5%). Alltogether, 77 patients (73.5%) received adjuvant hormonal therapy. Charts were reviewed retrospectively to obtain data on preoperative PSA, preoperative biopsy Gleason score, pathohistological data of the prostatectomy specimen. Progression-free, PSA-specific survival and cancer specific survival were determined by the Kaplan-Meier method.
Results: Median follow-up is 6.9 (0.2-10) years. Pathohistological stage distribution was pT2 in 26.5%, pT3 in 44.7% and pTxN+ in 28.5% of the patients. Positive surgical margins were achieved in 45 (42.8%). Overall survival and cancer specific survival is 85.9% and 89.5%, PSA - progression-free survival is 28%. Pathological stage (p<0.001), lymph node involvement (p<0.02) and preoperative PSA (p<0.01) were independent prognostic risk factors associated with progression-free survival. Cancer-specific and PSA-free survival in pT2 PCA is 98% and 92%, resp. 1-year continence is good with 86% requiring < 1pad/day. None of the patients developed local symptoms.
Conclusion: Gleason 8-10 PCA can be locally controlled with RPE in patients with organ confined disease resulting in a cancer specific survival of 98%. However, patients with pTxN+ or pT3b PCA will ultimately progress despite adjuvant hormonal therapy and these patients most probably would benefit from a more aggressive adjuvant approach. RPE remains a valuable therapeutic in high-grade prostate cancer.